Wiki 52648

[lmbsports]

we are getting a denial for 52648 stating only billable once in a lifetime. Patient did have 52648 back in 2012 and we are doing again in 2015. Has anyone billed more than once and gotten paid. I know I have to do an appeal, but not sure what information to send because I am not seeing a medicare policy for this code.

 

[emcee101]

I have billed this procedure hundreds if not a thousand times, and on several patients who had the procedure more than once in a lifetime. I never had a problem getting this procedure paid when being performed more than once on the same patient.

Did you call and verify benefits on the patient for this procedure before it was performed? The only thing I can think of is that this is specific to the insurance company or plan specific for the insurance that the patient carries. Befire filing an appeal I would contant the insurance company and talk to someone in claims and/or benefits to figure this out so you know the best route to move forward with the appeal.